兒科學(xué)-驚厥(英文)

AcuteconvulsioninChildren

1contentsDefinitionsCausesofacuteconvulsion

FebrileseizuresBacterialMeningitisExamsandTestsforconvulsionTreatmentofacuteconvulsionAcuteconvulsioninChildren2DefinitionsEpilepticSeizures（癲癇發(fā)作）

·manifestationoftransientexcessiveabnormalhypersynchronousdischargesofcorticalneurons·Clinicalsignsorsymptomsofseizuresdependonthelocationoftheepilepticdischargesinthecortexandtheextentandpatternofthepropagationoftheepilepticdischargeinthebrain.Maybemanifestedasamotor,sensory,autonomic,cognitive,orpsychicdisturbance·manifestationisapparenteithertothesubjectoranobserverDifferenttypesofseizuresmayoccurindifferentpartsofthebrainandmaybelocalized(affectonlyapartofthebody)orwidespread(affectthewholebody).AcuteconvulsioninChildren3DefinitionsConvulsiveseizures(驚厥性癲癇發(fā)作，convulsion驚厥):isasubtypeofseizureinwhichabnormalmotoractivityoccurs,notedbyuncontrollablemusclejerkingEpilepsy（癲癇）:achronicdisorderofthebraincharacterizedbyrecurrent,unprovokedepilepticseizures.AcuteconvulsioninChildren4癲癇發(fā)作（癇性發(fā)作，epilepticseizures或seizures）

大腦皮層神經(jīng)元異常同步放電引起的暫時性腦功能異常

臨床可有多種發(fā)作癥狀（包括運動、感覺異常、行為認知、植物神經(jīng)功能障礙等）分為驚厥性癇樣發(fā)作（驚厥）、非驚厥性癇樣發(fā)作發(fā)作性、并有自限性、大多短暫可發(fā)生于急性疾病、慢性疾病5驚厥（Convulsion）神經(jīng)元異常放電：起源于大腦皮層運動區(qū)腦功能障礙基本表現(xiàn)：抽搐（全身或局部骨骼肌的不自主收縮）可伴有不同程度意識障礙定義6ClassificationofEpilepticSeizures

(InternationalLeagueAgainstEpilepsy,1981)一、Focalseizures

(局灶性發(fā)作)1、單純局灶性發(fā)作（simplefocalseizures,consciousnessnotimpaired)

運動性發(fā)作(withmotorsigns)

感覺性發(fā)作(withsomatosensoryorspecial-sensorysymptoms)

植物神經(jīng)癥狀發(fā)作(withautonomicsymptomsorsigns)

精神癥狀性發(fā)作(withpsychicsymptoms)2、復(fù)雜局灶性發(fā)作（complexfocalseizures,withimpairmentofconsciousness)3、局灶性發(fā)作繼發(fā)全面性發(fā)作（focalseizuresevolvingtosecondarilygeneralizedseizures)二、Generalizedseizures(全面性發(fā)作)1、強直-陣攣性發(fā)作(tonic-clonicseizures)2、強直性發(fā)作(Tonicseizures)3、陣攣性發(fā)作(Clonicseizures)4、失神發(fā)作(Absenceseizures)5、肌陣攣發(fā)作(Myoclonicseizures)6、失張力發(fā)作(Atonicseizuresseizures)三、unclassifiedepilepticseizures(分類不明的發(fā)作)7excessiveabnormaldischargesofcorticalneuronsEpilepticSeizuresconvulsiveseizure(convulsion)

nonconvulsiveseizureAcuteepilepticseizure(provokedinacutedisorders)epilepsy(recurrent,unprovokedepilepticseizures)AcuteconvulsioninChildren8癲癇發(fā)作、驚厥、癲癇癲癇發(fā)作(EpilepticSeizures)：大腦神經(jīng)元異常放電所致發(fā)作性大腦皮層功能異常所引起的多種臨床癥狀驚厥(convulsion)：伴有骨骼肌強烈、不自主收縮的癇性發(fā)作癲癇(epilepsy)

：臨床呈長期反復(fù)癇性發(fā)作的疾病過程AcuteconvulsioninChildren9CharacteristicsofacuteconvulsioninchildrenHighincidence:4-6%inthechildrenyoungerthan6yrEasilywithprolongedconvulsionorstatusconvulsion

Statusconvulsion（驚厥持續(xù)狀態(tài)):aconvulsionlastinglongerthan30minutesorrepeatedconvulsionwithoutareturntonormalinbetweenthemusuallywithminimorsubtleseizureinthebabiesSeizuresmayoccurformanycausesAcuteconvulsioninChildren10contentsDefinitions(Seizure,Convulsion,Epilepsy)

Causesofacuteconvulsions

FebrileseizuresBacterialMeningitisExamsandTestsforconvulsionTreatmentofacuteconvulsionAcuteconvulsioninChildren11CommoncausesofacuteconvulsionCNSinfection:MeningitisorencephalitisFebrileconvulsions（Febrileseizures）HeadtraumaCNSmalformationsBraintumorsMetabolicdisorders:Hypoglycemia,Hyponatremia,hypernatremia,Hyperosmolarstates,HypocalcemiaIdiopathicorcryptogenicepilepsyAcuteconvulsioninChildren12ClassficationofthecausesofconvulsioninfectiousdiseasesotherdisordersIntracranialdiseaseBacterialMeningitis,Tuberculousmeningitis,Viralmeningitis/encephalitisfungalmeningitis,parasiticdisease,brainabscessHeadtraumaCNSmalformationsBraintumorsepilepsyExtracranialdiseaseFebrileconvulsionsInfectious-toxicencephalopathy

Anoxia,ischemiaMetabolicdisorders:

HypoglycemiaHyponatremiaHypernatremiaHypocalcemiaToxicosis

rodenticideorganicpesticideAcuteconvulsioninChildren13IntracranialinfectionUsuallywithinfectioussymptoms（fever、drowsiness、irritation、delirium）Recurrent,severe,prolongedseizureCommonoccurinearlystageorthemostseriousstageofdiseaseUsuallywiththedisturbanceofimpairmentofconsciousnessWiththemanifestationsofintracranialhypertensionUsefullabtest:CSF

Causesofacuteseizures14顱內(nèi)感染--腦膜炎、腦炎、腦寄生蟲病多有感染中毒癥狀（發(fā)熱、嗜睡、煩躁、激惹、譫妄）反復(fù)而嚴重的驚厥發(fā)作，持續(xù)時間長常見于疾病初期或極期多伴有進行性意識障礙伴有不同程度顱內(nèi)高壓表現(xiàn)腦脊液檢查有助診斷感染性病因15顱外感染—中毒性腦病大多見于嚴重細菌感染過程中與感染和毒素導(dǎo)致的腦水腫有關(guān)臨床特征：原發(fā)疾病極期反復(fù)驚厥發(fā)作伴有意識障礙與顱內(nèi)壓增高癥狀腦脊液檢查僅壓力增高感染性病因16Febrileseizures"Aneventininfancyorchildhoodusuallyoccurringbetweenthreemonthsandfiveyearsofage,associatedwithfever,butwithoutevidenceofintracranialinfectionoranidentifiableneurologicaldisorder”Febrileseizures17ClassficationofthecausesofconvulsioninfectiousdiseasesotherdisordersIntracranialdiseaseBacterialMeningitis,Tuberculousmeningitis,Viralmeningitis/encephalitisfungalmeningitis,parasiticdisease,brainabscessHeadtraumaCNSmalformationsBraintumorsepilepsyExtracranialdiseaseFebrileconvulsionsInfectious-toxicencephalopathy

Anoxia,ischemiaMetabolicdisorders:

HypoglycemiaHyponatremiaHypernatremiaHypocalcemiaToxicosis

rodenticideorganicpesticideAcuteconvulsioninChildren18非感染性病因--顱內(nèi)病變顱腦損傷（產(chǎn)傷、外傷、出血）傷后立即起病反復(fù)驚厥發(fā)作伴有意識障礙與顱內(nèi)壓增高癥狀頭顱影像學(xué)檢查（CT、MRI）有助診斷非感染性病因19非感染性病因--顱內(nèi)病變顱腦發(fā)育畸形（顱腦發(fā)育異常、腦積水）常呈反復(fù)發(fā)作伴有智力和運動發(fā)育落后腫瘤常呈反復(fù)發(fā)作伴有顱內(nèi)壓增高定位體征病情進行性加重頭顱影像學(xué)檢查確診非感染性病因20非感染性病因--顱外病變?nèi)毖跞毖ㄖ舷?、溺水、休克、阿斯氏綜合征等）

缺血缺氧后立即起病反復(fù)驚厥發(fā)作伴有意識障礙與顱內(nèi)壓增高癥狀非感染性病因21非感染性病因--顱外病變代謝性疾病（水電解質(zhì)紊亂、遺傳代謝性）低鈣血癥（1.75-1.88mmol/L，游離鈣1.0mmol/L）低血糖癥（2.2mmol/L）低鎂血癥（0.8-1.2mmol/L）低鈉或高鈉血癥（136-146mmol/L）遺傳代謝性?。ū奖虬Y等）非感染性病因22非感染性病因--顱外病變中毒性（殺鼠藥、有機磷農(nóng)藥、中樞興奮藥）頑固性驚厥發(fā)作意識障礙肝、腎功能損傷非感染性病因23contentsDefinitions(Seizure,Convulsion,Epilepsy)

Causesofacuteconvulsion

FebrileseizuresBacterialMeningitisExamsandTestsforconvulsionTreatmentofacuteconvulsion24HistoryofpatientThecourseofcurrentseizureactivityTimeandnatureofonsetofseizureactivityInvolvementofextremitiesorotherbodypartsNatureofmovements(eg,eyemovements,flexion,extension,stiffeningofextremities),includinganyfocalmovementsanddetailsofpostictalneurologicdeficitIncontinenceCyanosis(perioralorfacial)DurationofseizureactivitypriortomedicalattentionMentalstatusaftercessationofseizureactivityExamsandTestsforseizures25HistoryofpatientFeverorintercurrentillnessesPriorhistoryofseizuresHeadinjury(recentandremote)CNSinfectionordisease(eg,meningitis,neurocutaneoussyndrome)IntoxicationortoxicexposureBirthhistoryanddevelopmentaldelayExamsandTestsforseizures26PhysicalExaminationObtaintemperatureandvitalsigns(importantintheinitialevaluation)ExamineforsignssuggestiveoftraumaorthepresenceofanintracranialshuntExamineforpapilledema(suggestingincreasedintracranialpressure)Examinefornuchalrigidity(suggestingmeningitis)ExamsandTestsforseizures27PhysicalExaminationExamineskinforfindingssuggestiveofneurocutaneoussyndromeExaminefeaturesofappropriateneurodevelopmentIdentifyanyfocalneurologicdeficits(maybe

indicativeofanunderlyingfocalstructurallesion

orpostictalToddparesis)ExamsandTestsforseizures28病因?qū)W診斷提示病史---年齡新生兒期：顱腦損傷、顱內(nèi)畸形、顱內(nèi)感染、代謝紊亂1-6月：顱內(nèi)感染、低鈣、嬰兒痙攣-3歲：熱性驚厥、顱內(nèi)感染、中毒性腦病、癲癇3歲以上：顱內(nèi)感染、中毒性腦病、癲癇、顱腦外傷29病因?qū)W診斷提示病史---季節(jié)夏秋季節(jié)：中毒性痢疾流行性乙型腦炎低血糖癥冬春季節(jié)：流行性腦脊髓膜炎肺炎中毒性腦病

VitD缺乏性低鈣驚厥30病因?qū)W診斷提示病史---是否伴發(fā)熱無熱者大多非感染性，但≤3月幼嬰、新生兒以及休克者例外發(fā)熱者大多為感染性，但驚厥持續(xù)狀態(tài)可致體溫升高病史---驚厥嚴重程度31LaboratoryEvaluation

Initiallaboratoryevaluationcaninclude:bloodanalysis(WBCcount),urinalysis,stoolexaminationSerumstudiesforglucose,electrolytes,calcium,andmagnesiumandtoxicologystudiesExamsandTestsforseizures32LaboratoryEvaluation

PerformaCTscanorMRIifthepatienthashadarecentheadtrauma,significantlyalteredmentalstatus,asignificantheadache,papilledema,or

abulgingfontanel.Consideralumbarpuncture(LP)inpatientswhohavefeverandastiffneckorwhohavefeverandareunconscious.Others:EEGExamsandTestsforseizures33病因?qū)W診斷提示實驗室檢查三大常規(guī)：白細胞計數(shù)、大便（中毒性菌?。┻x擇性生化檢查：血糖、Ca+、Mg+、Na+、肝腎功能腦脊液檢查：疑有顱內(nèi)病變者其它：EEG、頭CT/MRI34contentsDefinitions(Seizure,Convulsion,Epilepsy)

Causesofacuteconvulsion

FebrileseizuresBacterialMeningitisExamsandTestsforconvulsionTreatmentofacuteconvulsion35DZP（地西泮，安定）LZP（勞拉西泮，氯羥安定）PHT（苯妥因）PB（苯巴比妥）成人（mg/kg)iv0.15～0.250.115～2020小兒(mg/kg)iv0.3-0.5mg/kg0.05～0.52020小兒直腸用(mg/kg)0.5———最大輸注速率(mg/min)1250100最早止驚時間(min)1～36～1010～3020～30藥效維持時間(h)0.25～0.5＞12～2424＞48半衰期(h)301424100可能副作用:意識抑制約10～30min數(shù)小時無可數(shù)日呼吸抑制偶見偶見少見偶見低血壓少見少見偶見少見心律失常——心臟病者—搶救驚厥發(fā)作常用藥物表36TreatmentofseizurespromptcessationofseizureactivityDiazepam-Intravenouslyadministered(0.3-0.5mg/kg/dose);-Hasrapidonsetandshortdurationofseizurecontrol;-Donotadminister>1mg/minIVPinchildren;-Monitorforrespiratorydepression

acuteseizures37TreatmentofseizurespromptcessationofseizureactivityPhenobarbital-Hasslowonsetandlongdurationofseizurecontrol;-MajordisadvantagesaresignificantlydepressesmentalstatusandcausesrespiratorydifficultyDiazepam+Phenobarbital

acuteseizures38TreatmentofseizuresOthersSecuretheairwayAdministersupplemental100%oxygenInfuseintravenousfluidsandglucoseIncreasedintracranialpressurecontrollingIdentificationandtreatmentofunderlyingdiseaseacuteseizures39contentsDefinitions(Seizure,Convulsion,Epilepsy)

Causesofacuteconvulsion

Febrileseizures（熱性驚厥）

BacterialMeningitisExamsandTestsforconvulsionTreatmentofacuteconvulsionAcuteconvulsioninChildren40GeneralIntroduction"Aneventininfancyorchildhoodusuallyoccurringbetweenthreemonthsandfiveyearsofage,associatedwithfever,butwithoutevidenceofintracranialinfectionoranidentifiableneurologicaldisorder”Febrileseizuresarethemostcommonseizuredisorderinchildhood,affecting2–5%ofchildren.Febrileseizures41GeneralIntroductionAssociatedwithupperrespiratoryinfection,otitismedia,viralsyndromeGeneticpredispositionclearlycontributestotheoccurrenceofthisdisorderBedividedintosimplefebrileseizures,complexfebrileseizuresAmongchildrenwithfebrileseizures,about70-80%haveonlysimplefebrileseizures,othershavecomplexfebrileseizuresFebrileseizures42FeaturesofFebrileSeizureMostcommoncauseofseizuresinchildhood,usuallywithgoodprognosisAssociatedwithfever,usuallyoccurwhenbodytemperaturerisesrapidlyFebrileseizures43FeaturesofFebrileSeizureOccurintheabsenceofintracranialinfectionoranidentifiableneurologicaldisorder.Agedependent:6mon-3yr(peakageofonset:18-22moofage)WithnormalCNSstructureandfunctionFebrileseizures44FeaturesofFebrileSeizureNoafebrileseizurehistoryMostunderlyinginfectioncausethefevermaybeaviralinfectionGeneticpredisposition

genelocation:SFS:19p13-3;FSwithTLE:8q13-21;FS+:2q21-q33,19q13.1

Febrileseizures45SimplefebrileSeizure(SFS)Thesettingisfeverinachildaged6monthsto3yearsTypicallyseizureisgeneralized(tonic-clonic)Durationofseizure:afewsecondsto15minOnlyhasonceortwiceofseizuresduringaperiodofdisease

Febrileseizures46ComplexfebrileSeizure(CFS)Ageofseizureonset:6monthsto5years;<6moor>6yrsprolongedseizure:persistingformorethan15minRepeatedconvulsionsduringafebrileperiod(multipleseizuresoccurinclosesuccession).Afocalseizure.Recurrentseizure(≥5times)Febrileseizures47單純性FS（SFS）復(fù)雜性FS（CFS）發(fā)病率FS中80%FS中20%發(fā)作形式全身性發(fā)作，發(fā)作后不留任何異常神經(jīng)征局限性或不對稱性發(fā)作。發(fā)作后可留異常神經(jīng)征發(fā)作次數(shù)在一次熱程中僅有一次驚厥發(fā)作（2/3），少數(shù)2次（1/4-1/3）反復(fù)多次（叢集式發(fā)作：24小時內(nèi)反復(fù)發(fā)作≥2次）持續(xù)時間發(fā)作時間短暫，多數(shù)5～15分鐘內(nèi)發(fā)作時間長（≥15分鐘）復(fù)發(fā)總次數(shù)4次以內(nèi)5次以上熱性驚厥的分類及基本臨床特征48RiskfactorsforrecurrentfebrileseizuresYoungageattimeoffirstfebrileseizure:≤15moor18moFamilyhistoryofafebrileseizureinafirstdegreerelativeComplexfebrileSeizureBriefdurationbetweenfeveronsetandinitialseizure

Patientswithall4riskfactorshavegreaterthan70%chanceofrecurrence.Patientswithnoriskfactorshavelessthana20%chanceofrecurrence.Febrileseizures49RiskfactorsforepilepsyComplexfebrileseizure(aprolonged,orfocal,orrecurseizureinthesameillness)FamilyhistoryofepilepsyNeurologicalabnormality,anddevelopmentaldelay.

Childrenwithafebrileseizurehaveaslightincreaseintheincidenceofepilepsycomparedwiththegeneralpopulation(1%vs0.5%).Patientswith2riskfactorshaveupto10%chanceofdevelopingafebrileseizures.Febrileseizures50ManagementIdentificationandtreatmentofunderlyinginfectionKeepingthepatientcoolwithregularantipyreticsTerminationofaprolongedconvulsion(diazepam,ivorrectally)ParentaleducationEffectivedrugsforpreventingrecurrentfebrileseizure:Phenobarbital,Sodiumvalproate,diazepamFebrileseizures51contentsDefinitions(Seizure,Convulsion,Epilepsy)

Causesofacuteconvulsion

Febrileseizures

BacterialMeningitis（細菌性腦膜炎）ExamsandTestsforconvulsionTreatmentofacuteconvulsion52Thebrainandspinalcordarecoveredby3connectivetissuelayerscollectivelycalledthemeningeswhichformtheblood-brainbarrier.DefinitionWhatismeningitis?

Bacterialmeningitisisanpurulentinflammationofthemeninges

causedbyvariousbacteria,mayalsobereferredtoas“purulentmeningitis”becauseofclassicCSFfindings,“purulent”appearance.BacterialMeningitis53GeneralIntroductionBacterialMeningitis:infectionofcentralnervoussystem(CNS);arapidlyprogressive,diffuseinfectioninvolvingthemeningsandcerebrospinalfluid(CSF)Peakageofincidence:youngerthan5yearsoldBacterialMeningitis54GeneralIntroductionCommonclinicalfeatures:fever,increasedintracranialpressure,meningealirritationAseriousinfectioninchildren:witha5-10%mortality,highriskofneurologicalsequelae(30%)EarlydiagnosisandeffectivetreatmentimprovetheoutcomeBacterialMeningitis55EtiologyPathogensMainpathogens-Neissriameningitidis-streptoccuspneumoniae-Haemophilusinfluenzae

主要人群中致病菌

腦膜炎雙球菌肺炎鏈球菌流感嗜血桿菌三種菌占小兒腦膜炎2/3以上56EtiologyPathogensinspecialpopulations

(neonate&<3moinfants,malnutrition,immunodeficiency)-gramnegativeentericbacilli-groupBstreptococci-staphlococcusaureus特殊人群中致病菌（3個月以下幼嬰、營養(yǎng)不良、免疫缺陷者）

易發(fā)生大腸桿菌、葡萄球菌、甚至綠膿桿菌等感染57PathologyStructureofmeningesBacterialMeningitis58PathologyPolymorphonuclearleukocytesinfiltrationintoleptomeningealandperivascular,forminganinflammatoryexudateBrainedema,hydrocephalus,cerebralinfarctionBacterialMeningitis59Clinicalmanifestationsage：90%<5yr，peakwithinfirstyearoflife

Hib:3mon-3yr(50%of<1yr)

Strepp.:80％casesagedbelow1yr

Neisseriameningitidis:<15yrSeason:Strepp.——winter(spring)MeningN.——winter/spring

Hib——earlywinter(autumn)/springBacterialMeningitis60ClinicalmanifestationsCommonfeaturesofmeningitis-Signsofsystemicinfectionfever,anorexia,shock,alterationofmentalstatusandconsciousness,seizure-Increasedintracranialpressure-MeningealirritationAtypicalmanifestationsofmeningitisBacterialMeningitis61ClinicalmanifestationsSignsofInfection:Fever,sepsis-likeappearance,Petechiae,shockAlterationofmentalstatusandconsciousness:Irritability,Drowsiness,lethargy,coma,SeizureIncreasedintracranialpressure:headache,vomiting,herniationMeningealirritation:nuchalrigidity,kernigsign(+),brudzinskisign(+)BacterialMeningitis62Whenflexingthehip90degreesandthenextendingtheleg,thepatientfeelssubsequentpain.BacterialMeningitis63Whenpassivelyflexingtheneckwhilesupine,patientinvoluntarilyflexeshiskneesandhips.BacterialMeningitis64MeningitisinneonatesandyoungerbabiesClinicalfindingsarenonspecificfeverisoftenabsent/hypothermiaSepsis-likemanifestations(refusaloffeedings,pale/greyskin)NothaveobviousseizureandIncreasedintracranialpressureHyperactivities,fixedeyesVomiting,highpitchedcryAfull,tense,orbulgingfontanelBacterialMeningitis65SignsofsystemicinfectionIncreasedintracranialpressuremeningealirritationTypical(olderchildren)Fever,alteredconsciousness,seizureHeadache,vomiting,herniationnuchalrigidity,backpain,kernigsign,brudzinskisignAtypical(neonate&<3moinfant)Fever,normaltemperatureorhypothermia;minimorsubtleseizure;poorfeeding;lessactivityScream,frown;bulgingorfullfontanel;wideningofthesuturesNotevidentComparisonofthemanifestationsofmeningitisbetweendifferentagegroupsBacterialMeningitis66LaboratoryTestsforSuspected

BacterialMeningitis

LumbarpuncturetoobtainCSFCellcountwithdifferentialGlucose&proteinlevels(serumglucoselevel)Gramstain&bacterialculturesDetectionforspecificantigensofbacteriaBlood&urineculturesforbacteriaBrainCTorMRIscanfordeterminingpathologicalarea&complicationsBacterialMeningitis67LaboratoryFindingsAnalysisofCSFSuggestionbacterialmeningitisHighpressureAppearance:slightlycloudytopurulentanincreasedWBCcount(1000X106/L,withneutrophilpredominanceRaisedproteinconcentration(>1g/L),decreasedglucoseconcentration(<50%ofserumsugarconcentration)BacterialMeningitis68LaboratoryFindingsAnalysisofCSFConfirmationofthediagnosis:identifytheorganismGram-stainedsmearofCSF:positivein70-90%ofcasesCSFculture:positivein80%ofcasesrapidantigen-detectiontestofCSF:PCRBacterialMeningitis69Diagnosis

EarlierdiagnosisgreatlyimprovestheoutcomeSuspectedcases:febrileinfantswithseizure,meningealirritability,increasedintracranialpressure,alteredmentalstatusPayattentiontotheatypicalsymptomsandsigns.ConfirmedbyanalysisofCSFLumbarpuncturetoobtainandanalysisCSF

BacterialMeningitis70DifferentialdiagnosisViralmeningitisLessseveresystemicinfectioussymptomsLimiteddurationofdisease:Usuallynotdevelopafter2-3weeksCSF:normalglucoseBacterialMeningitis71Differentialdiagnosis

TuberculousmeningitisSubacuteonsetandprogressClosecontactedwithknowncasesoftuberculosis

Evidenceofacuteorhealedtubercularinfectiononchestx-rayTuberculinskintest:OT,PPD

CSFBacterialMeningitis72DiseasePressure(Kpa)aspectTotalWBC(x106/L)Protein(g/L)Glucose(mmol/L)smearsculturesnormal0.69-1.96(0.29-0.78)clear0-5(0-20)0.2-0.4(0.2-1.2)2.2-4.4--Bacterialmeningitiscloudy(PMN)(1-5)(<2.2)Gram’sstain++TuberculousmeningitisNormalorcloudy(MN)AFBstain+Viralmeningitis/encephalitisNormalorNormalNormalor(MN)Normalor(<1)normal-TypicalchangesofCSFinCNSinfectionsBacterialMeningitis73Complicationsandsequelae

SubduraleffusionVentriculitisHydrocephalusOthersDeafnessBlindnessParalysisEpilepsymentalretardationBacterialMeningitis74PathologyStructureofmeningesBacterialMeningitis75Complicationsandsequelae

SubduraleffusionDefinitivediagnosis:volumeoffluidinsubduralspace>2ml,protein>0.4g/L,occurin30-60%ofpatients,commonininfants4-6monthofageCausativeorganisms:45%causedbyHinfluenzae,30%bySpneumoniaeBacterialMeningitis76Complicationsandsequelae

Subduraleffusionindications

-Noresponsetoasensitiveantibiotictherapy-Prolongedfeverorfeverreoccurringafteranafebrileinterval-Bulgingfontanel,wideningofsutures,enlargingheadcircumference,emesis,seizure,alteredconsciousness.-ImprovedCSFprofilewithmoreseriousclinicalmanifestationsBacterialMeningitis77Complicationsandsequelae

SubduraleffusionDiagnosismethods